Prevention Is The New Treatment

The Mind Diet is associated with a 53% reduction in the development of dementia but consuming an even more ideal diet as part of a healthy lifestyle demonstrates that dementia is over 90% preventable.  Prevention is the New Treatment. These are the thoughts communicated in a podcast hosted by the authors of The Alzheimer's Solution, Dean and Ayesha SherzaiI. They are the co-directors of the Alzheimer's Prevention Program at Cedars-Sinai Medical Center in Los Angeles, California and their words both resonate with and haunt me.

When I say prevention resonates with me, I am referring to a deep-in-my-soul, life changing resonation. I left the security of a respected and established group practice in January 2010 and opened a solo primary care practice seeking a greater emphasis on wellness and prevention. Going through my residency in Internal Medicine at the University of North Carolina at Chapel Hill in the early to mid 1990s there was an expectation that stricter management of blood pressure, blood sugar and cholesterol would prevent more damage to our body than it turned out to prevent.  After a heart attack we can prescribe aspirin, beta-blocker, statin and an ACE inhibitor and see a 70% reduction in the chance of experiencing a second event and a 70% reduction in the rate of dying in the next couple years when compared to no treatment. I remember celebrating this milestone thinking that most of the complications of American's leading cause of chronic disease and death (heart disease) could be eliminated. Unfortunately, as we extend the monitoring timeline from 2-3 years to 10 years, we see that 70% of those who experience a blocked artery event, such as stroke, heart attack or undergo a procedure such as heart bypass surgery or coronary artery stenting, will experience another blocked artery event even taking the cocktail of medications and getting to the great numbers we strive for.  This realization that we were not yet even half way toward the goal preventing heart attacks and strokes with our current tools and prescriptions led to the launching of heart attack prevention clinics in the early 2000s. The main lessons learned to date is that we do not have the ability to out-prescribe an unhealthy lifestyle.

When I became aware that leaders in the lifestyle medicine field claimed that over 90% of strokes and heart attacks were preventable, I wanted my practice to be ready to integrate the lifestyle medicine lessons our thought leaders and pioneers in cardiovascular health prevention and management were learning.

Even today our medical prescription based standard of care does not deliver on the hope to stabilize and reverse hardening of the artery events, although there is a fortunate "tip of the iceberg" who seem to experience that.  For the vast majority of Americans who are identified as having cardiovascular disease, the American standard of medical care is just trying to slow down the progression. We can do better and thankfully many do.

When I see my patients doing better, it is the result of their making healthier choices and enjoying the benefits of those choices.  The success they enjoy produces the jet stream that motivates and carries me forward. It helps me to make more effective presentations so that even more of my patients can experience the benefits of better health.

The lessons that have come out of lifestyle medicine and the early cardiovascular prevention clinics now give us wonderful tools to tame what Peter Attia, in his book "Outlive", calls the four horsemen of chronic disease and aging: (1)heart disease, (2)cancer, (3)neurodegenerative disease and (4)type 2 diabetes and related metabolic dysfunction.

So what is it about these great outcomes haunt me? First, not enough of us experience great health.  The horsemen win too often.  When I take my eyes off those who have extraordinary outcomes and see those who are left behind I get discouraged. The answer as to how to win these battles may be understood, but public confusion abounds and our human nature gets in the way as we gravitate back into typical, unhealthy American lifestyle habits.  I struggle with the question as to how I could make a more effective presentation and how we in the practice can provide more support, guidance and encouragement that would help drive better outcomes. Second, I don't know everything I want to know.  It makes me laugh to see that thought written down but I think it captures what I'm trying to communicate. You see, not too long ago I thought that I had assimilated the essential tools to carry me through another decade in medicine. I had become certified in a protocol to prevent and manage cardiovascular disease.  Added to that, the insights from lifestyle medicine that have proven helpful for my personal health were now being associated with lower cancer rates, better brain health, and slower aging overall. It seemed like the essentials of a whole package.  Then I start reading two books on Alzheimer's prevention and possible treatment and find myself questioning if I need to assimilate more tools on the medical tool belt. I decided that this blog was needed as one of those tools.

Before I get back to anything related to our cognitive health I am going to retrace some of the journey to this point with a focus on the additional insight learned from recent discoveries.  Here we will address topics individually such as lowering cholesterol, optimizing glucose, making sure we have all the key nutrient subsets in our weekly diet,  building an optimal gut microbiome, aerobic exercise, strength training, scheduling your day for optimal gene function (Hint: the example of the benefits of turning on and turning off MTOR gene),  I hope to also highlight how achieving these isolated goals integrates the common threads of health such as regulating inflammation, oxidation, immune function and aging.

I hope that you will join me for the journey and that we can make this a community event. Here we strive for progress over perfection. I ask that you highlight principles that were game-changing for you.  Add in specifics as to how you achieved progress building a healthy routine or a logistic that made it easier or more effective.  Encourage others by sharing your own good results and share our posts.